Search results for: long gap atresia treatment

Authors: Celine Shi Ying Lee, Jong Jian Lee

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Background: Infectious keratitis is one of the leading causes of blindness worldwide. Prompt treatment with effective medication will control the infection early, preventing corneal scarring and visual loss. fluoroquinolones ophthalmic medication is used because of its broad-spectrum properties, potency, good intraocular penetration, and low toxicity. The study aims to evaluate the treatment outcome of corneal ulcers using Levofloxacin 1.5% ophthalmic solution (LVFX) with adjuvant oral ciprofloxacin when indicated and apply this treatment strategy in primary health care as first-line treatment. Methods: Patients with infective corneal ulcer treated in an eye center were recruited. Inclusion criteria includes Corneal infection consistent with bacterial keratitis, single or multiple small corneal ulcers. Treatment regime: LVFX hourly for the first 2 days, 2 hourly from the 3rd day, and 3 hourly on the 5th day of review. Adjuvant oral ciprofloxacin 500mg BD was administered for 5 days if there were multiple corneal ulcers or when the location of the cornea ulcer was central or paracentral. Results: 47 subjects were recruited. There were 16 (34%) males and 31 (66%) females. 40 subjects (85%) were contact lens (CL) related to corneal ulcer, and 7 subjects (15%) were non-contact lens related. 42 subjects (89%) presented with one ulcer, of which 20 of them (48%) needed adjuvant therapy. 5 subjects presented with 2 or 3 ulcers, of which 3 needed adjuvant therapy. A total of 23 subjects (49%) was given adjuvant therapy (oral ciprofloxacin 500mg BD for 5 days).21 of them (91%) were CL related. All subjects recovered fully, and the average duration of treatment was 3.7 days, with 49% of the subjects resolved on the 3rd day, 38% on the 5thday of and 13% on the 7thday. All subjects showed symptoms of relief of pain, light-sensitivity, and redness on the 3rd day with full visual recovery post-treatment. No adverse drug reactions were recorded. Conclusion: Our treatment regime demonstrated good clinical outcome as first-line treatment for corneal ulcers. A corneal ulcer is a common eye condition in Singapore, mainly due to CL wear. Pseudomonas aeruginosa is the most frequent and potentially sight-threatening pathogen involved in CL related corneal ulcer. Coagulase-negative Staphylococci, Staphylococcus aureus, and Streptococcus Pneumoniae were seen in non-CL users. All these bacteria exhibit good sensitivity rates to ciprofloxacin and levofloxacin. It is therefore logical in our study to use LVFX Eyedrops and adjuvant ciprofloxacin oral antibiotics when indicated as first line treatment for most corneal ulcers. Our study of patients, both CL related and non-CL related, have shown good clinical response and full recovery using the above treatment strategy. There was also a full restoration of visual acuity in all the patients. Eye-trained primary Healthcare practitioners can consider adopting this treatment strategy as first line treatment in patients with corneal ulcers. This is relevant during the COVID pandemic, where hospitals are overwhelmed with patients and in regions with limited access to specialist eye care. This strategy would enable early treatment with better clinical outcome.

Keywords: corneal ulcer, levofloxacin hydrate, treatment strategy, ciprofloxacin

Procedia PDF Downloads 159

Authors: Marina Arino Martin, John McEvoy, Eakalak Khan

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Endoxifen is an active metabolite responsible for the effectiveness of tamoxifen, a chemotherapeutic drug widely used for endocrine responsive breast cancer and chemo-preventive long-term treatment. Tamoxifen and endoxifen are not completely metabolized in human body and are actively excreted. As a result, they are released to the water environment via wastewater treatment plants (WWTPs). The presence of tamoxifen in the environment produces negative effects on aquatic lives due to its antiestrogenic activity. Because endoxifen is 30-100 times more potent than tamoxifen itself and also presents antiestrogenic activity, its presence in the water environment could result in even more toxic effects on aquatic lives compared to tamoxifen. Data on actual concentrations of endoxifen in the environment is limited due to recent discovery of endoxifen pharmaceutical activity. However, endoxifen has been detected in hospital and municipal wastewater effluents. The detection of endoxifen in wastewater effluents questions the treatment efficiency of WWTPs. Studies reporting information about endoxifen removal in WWTPs are also scarce. There was a study that used chlorination to eliminate endoxifen in wastewater. However, an inefficient degradation of endoxifen by chlorination and the production of hazardous disinfection by-products were observed. Therefore, there is a need to remove endoxifen from wastewater prior to chlorination in order to reduce the potential release of endoxifen into the environment and its possible effects. The aim of this research is to isolate and identify bacteria strain(s) capable of degrading endoxifen into less hazardous compound(s). For this purpose, bacteria strains from WWTPs were exposed to endoxifen as a sole carbon and nitrogen source for 40 days. Bacteria presenting positive growth were isolated and tested for endoxifen biodegradation. Endoxifen concentration and by-product formation were monitored. The Monod kinetic model was used to determine endoxifen biodegradation rate. Preliminary results of the study suggest that isolated bacteria from WWTPs are able to growth in presence of endoxifen as a sole carbon and nitrogen source. Ongoing work includes identification of these bacteria strains and by-product(s) of endoxifen biodegradation.

Keywords: biodegradation, bacterial degraders, endoxifen, wastewater

Procedia PDF Downloads 197

Authors: Katharina Schuck

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For a long time, luxury hotels devoted little effort to sustainability, and also scientists were fairly attracted to this subject. While some luxury hotels are now increasingly showing engagement in sustainability, the extent of their commitment varies greatly, which makes the whole industry quite intransparent when it comes to sustainable practices. In general, each hotel companyand each individual hotel can decide for themselves to what extent they commit to sustainability as long as there are no legally prescribed minimum requirements in the respective countries. Despite pleading and compelling calls from industry experts and representatives of relevant sustainability institutions, this is still reality – although climate change and environmental disasters as well as poor treatment of workers and the local population are also issues in progressive and hotel-dense European cities. This paper therefore deals with the question which sustainability activities (environmental and social) have been established by European luxury hotels so far and to what extent these activities are rather a way to differentiate in the market or are simply evaluated as part of a necessary adaptation of the luxury hotel industry. For this purpose, interviews were conducted with both industry experts and hotel representatives in order to obtain a diverse picture of the current status. The studyrevealed that a clear agenda is missing so far, which takes luxury hotels by the handand supports them in the process towards more sustainable hotel management. While a large part of the luxury hotels addressed have already established initiatives and activities regarding sustainability, they are extremely diverse, and range from recyclable toiletries use to comprehensive concepts for energy generation. The study's findings provide insights for both practitioners who seek to implement sustainability in a luxury hotel setting as well as offer an extension of the existing research base on sustainability in hospitality.

Keywords: luxury hospitality, qualitative research methods, sustainability, sustainable hotels

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Authors: Nthatisi I. Molefe-Nyembe, Keisuke Suganuma, Oriel M. M. Thekisoe, Xuan Xuenan, Noboru Inoue

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African trypanosomosis is a devastating disease of animals caused by parasites of the genus Trypanosoma negatively affecting the economic status of more than 36 African countries. Few available drugs for the treatment of trypanosomosis remain inaccessible in remote areas, are associated with severe toxicity and most importantly, resistance has widely developed against their usage. Therefore, safe, effective and easily administrable drugs are urgently in need. The objective of the current study was to determine efficacy of azithromycin (AZM), on T. congolense, T. brucei brucei in vitro and in vivo. A 96 well luciferase assay was conducted to determine the trypanocidal effect of AZM on T. congolense, T. b. brucei and T. evansi as well as the cytotoxicity effect on the MDBK and NIH 3T3 cells. Additionally, TEM analysis was conducted to determine the morphological alteration on the AZM treated samples. Mice were infected with T. congolense and T. b. brucei and orally treated with AZM for 7 and 28 days referred to as the short and the long-term treatment. The in vitro IC50 values of AZM on T. congolense, T. b. brucei and T. evansi was 0.19 ± 0.17; 3.69 ± 2.26 and 1.81 ± 1.82 μg/mL, respectively, while the cytotoxicity effects values were greater than 25 μg/mL. A vacuole-like structure was observed in the TEM imaging of AZM treated T. congolense, while the presence of glycosomes and acidocalcisome-like structured were detected in T. b. brucei samples. In vivo, AZM was more effective against T. congolense infected mice than T. b. brucei. In conclusion, AZM exhibited the trypanocidal effects on T. congolense and T. b. brucei infected mice. However, further studies are necessary to determine the metabolic pathway responsible for the observed efficacy.

Keywords: animal trypanosomosis, azithromycin, oral administration, trypanosoma congolense

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Authors: Ayobami Adeyemo, Michael Chimonyo, Munyaradzi Marufu

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Gastrointestinal nematode (GNT) infection significantly hinder sustainable and profitable sheep production on rangelands. While vitamin E and protein supplementation have individually proven to improve host immunity to parasitism in lambs, to our knowledge, there is no information on the interaction of dietary vitamin E and protein supplementation on lamb growth and GIN faecal egg counts in naturally infected lambs. Therefore, the current study investigated the interaction of dietary protein and vitamin E supplementation on faecal egg counts (FEC) and growth performance of lambs. Twenty four Dohne Merino lambs aged 12 months were allocated equally to each of four treatment combinations, with six lambs in each treatment group for a period of eight weeks. Treatment one lambs received dietary protein and vitamin E (PE), treatment two lambs received dietary protein and no vitamin E (PNE), treatment three received dietary vitamin E and no protein (NPE), and treatment four received no dietary protein and vitamin E supplementation (NPNE). The lambs were allowed to graze on Pennisetum clandestinum contaminated with a heavy load of nematodes. Dietary protein supplementation increased (P < 0.01) average daily gain (ADG) and body condition scores (BCS). Dietary vitamin E supplementation had no effect (P > 0.05) on ADG and BCS. There was no interaction (P > 0.05) between dietary protein and vitamin E supplementation on ADG and BCS. Combined supplementation of dietary protein and vitamin E supplementation significantly reduced (P < 0.01) faecal egg counts and larval counts, respectively. Also, dietary protein and vitamin E supplementation reduced GNT faecal egg counts over the exposure period. The current findings support the hypothesis that the interaction of dietary protein and vitamin E supplementation reduced faecal egg counts and larval counts in lambs. This necessitates future findings on the interaction of dietary protein and vitamin E supplementation on blood associated profiles.

Keywords: gastrointestinal nematodes, nematode eggs, Haemonchus, Trichostrongylus

Procedia PDF Downloads 187

Authors: Adegoke A. Adeyelu, Adeola T. Adeyelu, S. D. Y. Alfred, O. O. Fasina

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This study examines the use of traditional medicines for the treatment of selected illnesses among crop-farming households in Edo State, Nigeria. A sample size of ninety (90) households were randomly selected for the study. Data were collected with a structured questionnaire alongside focus group discussions (FGD). Result shows that the mean age was 50 years old, the majority (76.7%) of the sampled farmers were below 60 years old. The majority (80.0%) of the farmers were married, about (92.2%) had formal education. It exposes that the majority of the respondents (76.7%) had household size of between 1-10 persons, about 55.6% had spent 11 years and above in crop farming. malaria (8th ), waist pains (7th ), farm injuries ( 6th ), cough (5th), acute headache(4th), skin infection (3rd), typhoid (2nd) and tuberculosis (1st ) were the most and least treated illness. Respondents (80%) had spent N10,000.00 ($27) and less on treatment of illnesses, 8.9% had spent N10,000.00-N20,000.0027 ($27-$55) 4.4% had spent between N20,100-N30,000.00 ($27-$83) while 6.7% had spent more than N30,100.00 ($83) on treatment of illnesses in the last one (1) year prior to the study. Age, years of farming, farm size, household size, level of income, cost of treatment, level of education, social network, and culture are some of the statistically significant factors influencing the utilization of traditional medicine. Farmers should be educated on methods of preventing illnesses, which is far cheaper than the curative.

Keywords: crop farming-households, selected illnesses, traditional medicines, Edo State

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Authors: Abdelkader T. Ahmed

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Greywater is any wastewater draining from a household including kitchen sinks and bathroom tubs, except toilet wastes. Although this used water may contain grease, food particles, hair, and any number of other impurities, it may still be suitable for reuse after treatment. Greywater reusing serves two purposes including reduction the amount of freshwater needed to supply a household, and reduction the amount of wastewater entering sewer systems. This study aims to investigate and design a simple and cheap unit to treat the greywater in household via using ceramic membranes and reuse it in supplying water for toilet flushing. The study include an experimental program for manufacturing several tablet ceramic membranes from clay and sawdust with three different mixtures. The productivity and efficiency of these ceramic membranes were investigated by chemical and physical tests for greywater before and after filtration through these membranes. Then a treatment unit from this ceramic membrane was designed based on the experimental results of lab tests. Results showed that increase sawdust percent with the mixture increase the flow rate and productivity of treated water but decrease in the same time the water quality. The efficiency of the new ceramic membrane reached 95%. The treatment unit save 0.3 m3/day water for toilet flushing without need to consume them from the fresh water supply network.

Keywords: ceramic membranes, filtration, greywater, wastewater treatment

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Authors: Christian Klettner, Ian Eames, Tristan Robinson

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Tsunami is characterised by their very long time periods and can have devastating consequences when these inundate through built-up coastal regions as in the 2004 Indian Ocean and 2011 Tohoku Tsunami. This work aims to investigate the effect of these long waves on the flow through and around a group of buildings, which are abstracted to circular cylinders. The research approach used in this study was using experiments and numerical simulations. Large-scale experiments were carried out at HR Wallingford. The novelty of these experiments is (I) the number of bodies present (up to 64), (II) the long wavelength of the input waves (80 seconds) and (III) the width of the tank (4m) which gives the unique opportunity to investigate three length scales, namely the diameter of the building, the diameter of the array and the width of the tank. To complement the experiments, dam break flow past the same arrays is investigated using three-dimensional numerical simulations in OpenFOAM. Dam break flow was chosen as it is often used as a surrogate for the tsunami in previous research and is used here as there are well defined initial conditions and high quality previous experimental data for the case of a single cylinder is available. The focus of this work is to better understand the effect of the solid void fraction on the force and flow through and around the array. New qualitative and quantitative diagnostics are developed and tested to analyse the complex coupled interaction between the cylinders.

Keywords: computational fluid dynamics, tsunami, forces, complex geometry

Procedia PDF Downloads 176

Authors: Jeanne Gallee, Sofia Vallila-Rohter

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Technology-based applications are increasingly being utilized in aphasia rehabilitation as a means of increasing intensity of treatment and improving accessibility to treatment. These interactive therapies, often available on tablets, lead individuals to complete language and cognitive rehabilitation tasks that draw upon skills such as the ability to name items, recognize semantic features, count syllables, rhyme, and categorize objects. Tasks involve visual and auditory stimulus cues and provide feedback about the accuracy of a person’s response. Research has begun to examine the efficacy of tablet-based therapies for aphasia, yet much remains unknown about how individuals interact with these therapy applications. Thus, the current study aims to examine the efficacy of a tablet-based therapy program for anomia, further examining how strategy training might influence the way that individuals with aphasia engage with and benefit from therapy. Individuals with aphasia are enrolled in one of two treatment paradigms: traditional therapy or strategy therapy. For ten weeks, all participants receive 2 hours of weekly in-house therapy using Constant Therapy, a tablet-based therapy application. Participants are provided with iPads and are additionally encouraged to work on therapy tasks for one hour a day at home (home logins). For those enrolled in traditional therapy, in-house sessions involve completing therapy tasks while a clinician researcher is present. For those enrolled in the strategy training group, in-house sessions focus on limiting cue use in order to maximize lexical retrieval attempts and naming opportunities. The strategy paradigm is based on the principle that retrieval attempts may foster long-term naming gains. Data have been collected from 7 participants with aphasia (3 in the traditional therapy group, 4 in the strategy training group). We examine cue use, latency of responses and accuracy through the course of therapy, comparing results across group and setting (in-house sessions vs. home logins).

Keywords: aphasia, speech-language pathology, traumatic brain injury, language

Procedia PDF Downloads 189

Authors: Babak Forouraghi

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A genetic circuit is a collection of interacting genes and proteins that enable individual cells to implement and perform vital biological functions such as cell division, growth, death, and signaling. In cell engineering, synthetic gene circuits are engineered networks of genes specifically designed to implement functionalities that are not evolved by nature. These engineered networks enable scientists to tackle complex problems such as engineering cells to produce therapeutics within the patient's body, altering T cells to target cancer-related antigens for treatment, improving antibody production using engineered cells, tissue engineering, and production of genetically modified plants and livestock. Construction of computational models to realize genetic circuits is an especially challenging task since it requires the discovery of flow of genetic information in complex biological systems. Building synthetic biological models is also a time-consuming process with relatively low prediction accuracy for highly complex genetic circuits. The primary goal of this study was to investigate the utility of a pre-trained bidirectional encoder transformer that can accurately predict gene expressions in genetic circuit designs. The main reason behind using transformers is their innate ability (attention mechanism) to take account of the semantic context present in long DNA chains that are heavily dependent on spatial representation of their constituent genes. Previous approaches to gene circuit design, such as CNN and RNN architectures, are unable to capture semantic dependencies in long contexts as required in most real-world applications of synthetic biology. For instance, RNN models (LSTM, GRU), although able to learn long-term dependencies, greatly suffer from vanishing gradient and low-efficiency problem when they sequentially process past states and compresses contextual information into a bottleneck with long input sequences. In other words, these architectures are not equipped with the necessary attention mechanisms to follow a long chain of genes with thousands of tokens. To address the above-mentioned limitations of previous approaches, a transformer model was built in this work as a variation to the existing DNA Bidirectional Encoder Representations from Transformers (DNABERT) model. It is shown that the proposed transformer is capable of capturing contextual information from long input sequences with attention mechanism. In a previous work on genetic circuit design, the traditional approaches to classification and regression, such as Random Forrest, Support Vector Machine, and Artificial Neural Networks, were able to achieve reasonably high R2 accuracy levels of 0.95 to 0.97. However, the transformer model utilized in this work with its attention-based mechanism, was able to achieve a perfect accuracy level of 100%. Further, it is demonstrated that the efficiency of the transformer-based gene expression classifier is not dependent on presence of large amounts of training examples, which may be difficult to compile in many real-world gene circuit designs.

Keywords: transformers, generative ai, gene expression design, classification

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Authors: Jakub Perner, Jindrich Matousek, Hana Malinska

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Adverse environmental conditions at planting (especially water shortage) can lead into reduced germination rate of seeds. The plasma treatment is one of the possibilities that can solve this problem. Such treatment can increase the germination rate of seeds and make germs grow faster due to increased wettability of seeds surface or disrupted seed coat. This could lead to enhanced oxygen and water transport into the seed and improve germination. Poppy and flax seeds were treated in fluidized bed reactor, and discharge power ranging from 10 to 40 W was used. The working gas was air at pressure 100 Pa. Poppy seeds were then planted into Petri dishes on 7 layers of filter paper saturated with water, and the number of germinated seeds was observed from 3 to 6 days after planting. Every plasma treated sample showed improved germination rate compared to untreated seeds (75.5%) six days after planting. Samples treated in 40W discharge had the highest germination rate (81.2%). The decreased contact angle of water on treated poppy seeds was observed from 85° (untreated) to 30–35° (treated). Untreated flax seeds have a germination rate over 98%; therefore, the weight of seeds was taken to be a measure of the successful germination. Treated flax seeds had a slightly higher weight than untreated. Also, the contact angle of water decreased from 99° (untreated) to 65-73° (treated); therefore the treatment of both species is considered to be successful.

Keywords: flax, germination, plasma treatment, poppy

Procedia PDF Downloads 164

Authors: Fasil Wagnew, Kefyalew Addis Alene, Setegn Eshetie, Tom Wingfield, Matthew Kelly, Darren Gray

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Introduction: Undernutrition is a major and under-appreciated risk factor for TB, which is estimated to be responsible for 1.9 million TB cases per year globally. The effectiveness of micronutrient supplementation on TB treatment outcomes and its prognostic markers such as sputum conversion and serum zinc, retinol, and hemoglobin levels has been poorly understood. This systematic review and meta-analysis aimed to determine the association between zinc and vitamin A supplementation and TB treatment outcomes and its prognostic markers. Methods: A systematic literature search for randomized controlled trials (RCTs) was performed in PubMed, Embase, and Scopus databases. Meta-analysis with a random effect model was performed to estimate risk ratio (RR) and mean difference (MD), with a 95% confidence interval (CI), for dichotomous and continuous outcomes, respectively. Results: Our search identified 2,195 records. Of these, nine RCTs consisting of 1,375 participants were included in the final analyses. Among adults with pulmonary TB, zinc (RR: 0.94, 95%CI: 0.86, 1.03), vitamin A (RR: 0.90, 95%CI: 0.80, 1.01), and combined zinc and vitamin A (RR: 0.98, 95%CI: 0.89, 1.08) supplementation were not significantly associated with TB treatment success. Combined zinc and vitamin A supplementation was significantly associated with increased sputum smear conversion at 2 months (RR: 1.16, 95%CI: 1.03, 1.32), serum zinc levels at 2 months (MD of 0.86umol/l, 95% CI: 0.14, 1.57), serum retinol levels at 2 months (MD: 0.06umol/l, 95 % CI: 0.04, 0.08) and 6 months (MD: 0.12umol/l, 95 % CI: 0.10, 0.14), and serum hemoglobin level at 6 months (MD: 0.29 ug/dl, 95% CI: 0.08 to 0.51), among adults with TB. Conclusions: Providing zinc and vitamin A supplementation to adults with pulmonary TB during treatment may increase early sputum smear conversion, serum zinc, retinol, and hemoglobin levels. However, the use of zinc, vitamin A, or both were not associated with TB treatment success.

Keywords: zinc and vitamin A supplementation, tuberculosis, treatment outcomes, meta-analysis, RCT

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Authors: A. A. Agbor, Jean Joel R. Bigna, Serges Clotaire Billong, Mathurin Cyrille Tejiokem, Gabriel L. Ekali, Claudia S. Plottel, Jean Jacques N. Noubiap, Hortence Abessolo, Roselyne Toby, Sinata Koulla-Shiro

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Background: Contributors to fatal outcomes in patients undergoing tuberculosis (TB) treatment in the setting of HIV co-infection are poorly characterized, especially in sub-Saharan Africa. Our study’s aim was to assess factors associated with death in TB/HIV co-infected patients during the first 6 months their TB treatment. Methods: We conducted a tertiary-care hospital-based retrospective cohort study from January 2006 to December 2013 at the Yaoundé Central Hospital, Cameroon. We reviewed medical records to identify hospitalized co-infected TB/HIV patients aged 15 years and older. Death was defined as any death occurring during TB treatment, as per the World Health Organization’s recommendations. Logistic regression analysis identified factors associated with death. Magnitudes of associations were expressed by adjusted odds ratio (aOR) with 95% confidence interval. A p value < 0.05 was considered statistically significant. Results: The 337 patients enrolled had a mean age of 39.3 (+/- 10.3) years and more (54.3%) were women. TB treatment outcomes included: treatment success in 60.8% (n=205), death in 29.4% (n=99), not evaluated in 5.3% (n=18), loss to follow-up in 5.3% (n=14), and failure in 0.3% (n=1) . After exclusion of patients lost to follow-up and not evaluated, death in TB/HIV co-infected patients during TB treatment was associated with: a TB diagnosis made before national implementation of guidelines regarding initiation of antiretroviral therapy (aOR = 2.50 [1.31-4.78]; p = 0.006), the presence of other AIDS-defining infections (aOR = 2.73 [1.27-5.86]; p = 0.010), non-AIDS comorbidities (aOR = 3.35 [1.37-8.21]; p = 0.008), not receiving co-trimoxazole prophylaxis (aOR = 3.61 [1.71-7.63]; p = 0.001), not receiving antiretroviral therapy (aOR = 2.45 [1.18-5.08]; p = 0.016), and CD4 cell counts < 50 cells/mm3 (aOR = 16.43 [1.05-258.04]; p = 0.047). Conclusions: The success rate of anti-tuberculosis treatment among hospitalized TB/HIV co-infected patients in our setting is low. Mortality in the first 6 months of treatment was high and strongly associated with specific clinical factors including states of greater immunosuppression, highlighting the urgent need for targeted interventions, including provision of anti-retroviral therapy and co-trimoxazole prophylaxis in order to enhance patient outcomes.

Keywords: TB/HIV co-infection, death, treatment outcomes, factors

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Authors: Salako Rotimi, Oshungade Stephen, Ojewoye Opeyemi

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The maintenance of price stability is one of the macroeconomic challenges facing Nigeria as a nation. This paper attempts to build a co-integration multivariate time series model for inflation movement in Nigeria using data extracted from the abstract of statistics of the Central Bank of Nigeria (CBN) from 2008 to 2017. The Johansen cointegration test suggests at least one co-integration vector describing the long run relationship between Consumer Price Index (CPI), Food Price Index (FPI) and Non-Food Price Index (NFPI). All three series show increasing pattern, which indicates a sign of non-stationary in each of the series. Furthermore, model predictability was established with root-mean-square-error, mean absolute error, mean average percentage error, and Theil’s unbiased statistics for n-step forecasting. The result depicts that the long run coefficient of a consumer price index (CPI) has a positive long-run relationship with the food price index (FPI) and non-food price index (NFPI).

Keywords: economic, inflation, model, series

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Authors: Zahra R. Almansoor

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Background: Selective serotonin reuptake inhibitors (SSRI’s) and cognitive behavioural therapy (CBT) are the main treatment methods used for patients with obsessive compulsive disorder (OCD) under the National Institute of Health and Care Excellence (NICE) guidelines. Yet many patients are left with residual symptoms or remit, so several other therapeutic approaches have been explored. Objective: The objective was to systematically review the available literature regarding the treatment efficacy of current and potential approaches and diagnostic strategies. Method: First, studies were examined concerning diagnosis, prognosis, and influencing factors. Then, one reviewer conducted a systematic search of six databases using stringent search terms. Results of studies exploring the efficacy of treatment interventions were analysed and compared separately for adults and children. This review was limited to randomised controlled trials (RCT’s) conducted from 2016 onwards, and an improved Y-BOCS (Yale- Brown obsessive compulsive scale) score was the primary outcome measure. Results: Technology-based interventions including internet-based cognitive behavioural therapy (iCBT) were deemed as potentially effective. Discrepancy remains about the benefits of SSRI use past one year, but potential medication adjuncts include amantadine. Treatments such as association splitting and family and mindfulness strategies also have future potential. Conclusion: A range of potential therapies exist, either as treatment adjuncts to current interventions or as sole therapies. To further improve efficacy, it may be necessary to remodel the current NICE stepped-care model, especially regarding the potential use of lower intensity, cheaper treatments, including iCBT. Although many interventions show promise, further research is warranted to confirm this.

Keywords: family and group treatment, mindfulness strategies, novel treatment approaches, standard treatment, technology-based interventions

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Authors: Jamel Boukhatem, Semia Rachid, Marmar Nasr

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Considering the differences between oil- and non-oil-producing countries, this paper aims to evaluate the impact of financial development (FD) and institutional quality (IQ) on CO2 emissions in 15 MENA (Middle East and North Africa) countries over the period 1996-2018 using the Panel ARDL approach. We found evidence to support an unconditional long run effect of FD on environmental conditions (EC), with quite significant differences between the two groups of countries. While FD leads to environmental degradation (ED) in non-oil-producing countries, it helps protect the environment in oil-producing ones. Regarding the effects of IQ on EC, they are not significant in both short- and long run for non-oil-producing countries, but they are significant for oil-producing ones only in the long run. In the short run, IQ indicators haven’t significant effects on EC for the two groups of countries.

Keywords: financial development, institutional quality, environmental conditions, Panel ARDL

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Authors: Flavio Araujo, Paulo Scalize, Julio Lima, Natalia Vieira, Antonio Albuquerque, Isabela Santos

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From a concern regarding the environmental impacts caused by the disposal of residues generated in Water Treatment Plants (WTP's), alternatives ways have been studied to use these residues as raw material for manufacture of building materials, avoiding their discharge on water streams, disposal on sanitary landfills or incineration. This paper aims to present the results of a research work, which is using WTR for replacing the soil content in the manufacturing of soil-cement floor with proportions of 0, 5, 10 and 15%. The samples tests showed a reduction mechanical strength in so far as has increased the amount of waste. The water absorption was below the maximum of 6% required by the standard. The application of WTR contributes to the reduction of the environmental damage in the water treatment industry.

Keywords: residue, soil-cement floor, sustainable, WTP

Procedia PDF Downloads 551

Authors: Sirimanee Banjong

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This study aimed to 1) develop pre-service teachers’ leadership skills through camp-based learning, and 2) develop pre-service teachers’ teamwork skills through camp-based learning. An applied research methodology was used. The target group was derived from a purposive selection. It involved 32 fourth-year students in Early Childhood Education Program enrolling in a course entitled Seminar in Early Childhood Education provided during the second semester of the academic year 2013. The treatment was camp-based learning activities which applied a PDCA process including four stages: 1) plan, 2) do, 3) check, and 4) act. Research instruments were a learning camp program, a camp-based learning management plan, a 5-level assessment form for leadership skills and a 5-level assessment form for assessing teamwork skills. Data were analyzed using descriptive statistics. Results were: 1) pre-service teachers’ leadership skills yielded the before treatment average score at ¯("x" )=3.4, S.D.= 0.62 and the after-treatment average score at ¯("x" ) 4.29, S.D.=0.66 pre-service teachers’ teamwork skills yielded the before-treatment average score at ¯("x" )=3.31, S.D.= 0.60 and the after-treatment average score at ¯("x" )=4.42, S.D.= 0.66. Both differences were statistically significant at the .05 level. Thus, the pre-service teachers’ leadership and teamwork skills were significantly improved through the camp-based learning approach.

Keywords: learning camp, leadership skills, teamwork skills, pre-service teachers

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Authors: Iliana Georganta, Clare Deehan, Marysia Thomson, Miriam McDonald, Kerrie McNulty, Anna Strachan, Elizabeth Anderson, Alyaa Mostafa

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Context: A meta-analysis of randomized controlled trials (RCTs) comparing hysterectomy versus endometrial ablation and resection in the management of heavy menstrual bleeding. Objective: To evaluate the clinical efficacy, satisfaction rates and adverse events of hysterectomy compared to more minimally invasive techniques in the treatment of HMB. Evidence Acquisition: A literature search was performed for all RCTs and quasi-RCTs comparing hysterectomy with either endometrial ablation endometrial resection of both. The search had no language restrictions and was last updated in June 2020 using MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, PubMed, Google Scholar, PsycINFO, Clinicaltrials.gov and Clinical trials. EU. In addition, a manual search of the abstract databases of the European Haemophilia Conference on women's health was performed and further studies were identified from references of acquired papers. The primary outcomes were patient-reported and objective reduction in heavy menstrual bleeding up to 2 years and after 2 years. Secondary outcomes included satisfaction rates, pain, adverse events short and long term, quality of life and sexual function, further surgery, duration of surgery and hospital stay and time to return to work and normal activities. Data were analysed using RevMan software. Evidence synthesis: 12 studies and a total of 2028 women were included (hysterectomy: n = 977 women vs endometrial ablation or resection: n = 1051 women). Hysterectomy was compared with endometrial ablation only in five studies (Lin, Dickersin, Sesti, Jain, Cooper) and endometrial resection only in five studies (Gannon, Schulpher, O’Connor, Crosignani, Zupi) and a mixture of the Ablation and Resection in two studies (Elmantwe, Pinion). Of the 1² studies, 10 reported women’s perception of bleeding symptoms as improved. Meta-analysis showed that women in the hysterectomy group were more likely to show improvement in bleeding symptoms when compared with endometrial ablation or resection up to 2-year follow-up (RR 0.75, 95% CI 0.71 to 0.79, I² = 95%). Objective outcomes of improvement in bleeding also favored hysterectomy. Patient satisfaction was higher after hysterectomy within the 2 years follow-up (RR: 0.90, 95%CI: 0.86 to 0.94, I²:58%), however, there was no significant difference between the two groups at more than 2 years follow up. Sepsis (RR: 0.03, 95% CI 0.002 to 0.56; 1 study), wound infection (RR: 0.05, 95% CI: 0.01 to 0.28, I²: 0%, 3 studies) and Urinary tract infection (UTI) (RR: 0.20, 95% CI: 0.10 to 0.42, I²: 0%, 4 studies) all favoured hysteroscopic techniques. Fluid overload (RR: 7.80, 95% CI: 2.16 to 28.16, I² :0%, 4 studies) and perforation (RR: 5.42, 95% CI: 1.25 to 23.45, I²: 0%, 4 studies) however favoured hysterectomy in the short term. Conclusions: This meta-analysis has demonstrated that endometrial ablation and endometrial resection are both viable options when compared with hysterectomy for the treatment of heavy menstrual bleeding. Hysteroscopic procedures had better outcomes in the short term with fewer adverse events including wound infection, UTI and sepsis. The hysterectomy performed better when measuring more long-term impacts such as recurrence of symptoms, overall satisfaction at two years and the need for further treatment or surgery.

Keywords: menorrhagia, hysterectomy, ablation, resection

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Authors: Hsiang-Chun Lai, Hsien-Yin Liao, Yi-Wen Lin

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Migraine is a primary headache disorder which presented as recurrent and moderate to severe headaches and affects nearly fifteen percent of people’s daily life. In East Asia, acupuncture is a common treatment for migraine prevention. Acupuncture can modulate migraine through both peripheral and central mechanism and decrease the allodynia process. Molecular pathway suggests that acupuncture relief migraine by regulating neurotransmitters/neuromodulators. This process was also proven by neural imaging. Acupuncture decrease the headache frequency and intensity compared to routine care. We also review the most common chosen acupoints to treat migraine and its treatment protocol. As a result, we suggested that acupuncture can serve as an option to migraine treatment and prevention. However, more studies are needed to establish the mechanism and therapeutic roles of acupuncture in treating migraine.

Keywords: acupuncture, allodynia, headache, migraine

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Authors: Sachin B. Patil, Narendra M. Kanhe

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A typical cane molasses based distillery generates 15 L of waste water per liter of alcohol production. Distillery waste with COD of over 1,00,000 mg/l and BOD of over 30,000 mg/l ranks high amongst the pollutants produced by industries both in magnitude and strength. Treatment and safe disposal of this waste is a challenging task since long. The high strength of waste water renders aerobic treatment very expensive and physico-chemical processes have met with little success. Thermophilic anaerobic treatment of distillery waste may provide high degree of treatment and better recovery of biogas. It may prove more feasible in most part of tropical country like India, where temperature is suitable for thermophilic micro-organisms. Researchers have reviled that, at thermophilic conditions due to increased destruction rate of organic matter and pathogens, higher digestion rate can be achieved. Literature review reveals that the variety of anaerobic reactors including anaerobic lagoon, conventional digester, anaerobic filter, two staged fixed film reactors, sludge bed and granular bed reactors have been studied, but little attempts have been made to evaluate the usefulness of thermophilic anaerobic treatment for treating distillery waste. The present study has been carried out, to study feasibility of thermophilic anaerobic digestion to facilitate the design of full scale reactor. A pilot scale anaerobic fixed film fixed bed reactor (AFFFB) of capacity 25m3 was designed, fabricated, installed and commissioned for thermophilic (55-65°C) anaerobic digestion at a constant pH of 6.5-7.5, because these temperature and pH ranges are considered to be optimum for biogas recovery from distillery wastewater. In these conditions, working of the reactor was studied, for different hydraulic retention times (HRT) (0.25days to 12days) and variable organic loading rates (361.46 to 7.96 Kg COD/m3d). The parameters such as flow rate and temperature, various chemical parameters such as pH, chemical oxygen demands (COD), biogas quantity, and biogas composition were regularly monitored. It was observed that, with the increase in OLR, the biogas production was increased, but the specific biogas yield decreased. Similarly, with the increase in HRT, the biogas production got decrease, but the specific biogas yield was increased. This may also be due to the predominant activity of acid producers to methane producers at the higher substrate loading rates. From the present investigation, it can be concluded that for thermophilic conditions the highest COD removal percentage was obtained at an HRT of 08 days, thereafter it tends to decrease from 8 to 12 days HRT. There is a little difference between COD removal efficiency of 8 days HRT (74.03%) and 5 day HRT (78.06%), therefore it would not be feasible to increase the reactor size by 1.5 times for mere 4 percent more efficiency. Hence, 5 days HRT is considered to be optimum, at which the biogas yield was 98 m3/day and specific biogas yield was 0.385 CH4 m3/Kg CODr.

Keywords: spent wash, anaerobic digestion, biomass, biogas

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Authors: Priscila Ribeiro dos Santos, Luiz Antonio Daniel

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Inadequate access to clean water and sanitation has become one of the most widespread problems affecting people throughout the developing world, leading to an unceasing need for low-cost and sustainable wastewater treatment systems. The UASB technology has been widely employed as a suitable and economical option for the treatment of sewage in developing countries, which involves low initial investment, low energy requirements, low operation and maintenance costs, high loading capacity, short hydraulic retention times, long solids retention times and low sludge production. Whereas dissolved air flotation process is a good option for the post-treatment of anaerobic effluents, being capable of producing high quality effluents in terms of total suspended solids, chemical oxygen demand, phosphorus, and even pathogens. This work presents an evaluation and monitoring, over a period of 6 months, of one compact full-scale system with this configuration, UASB reactors followed by dissolved air flotation units (DAF), operating in Brazil. It was verified as a successful treatment system, and an issue of relevance since dissolved air flotation process treating UASB reactor effluents is not widely encompassed in the literature. The study covered the removal and behavior of several variables, such as turbidity, total suspend solids (TSS), chemical oxygen demand (COD), Escherichia coli, total coliforms and Clostridium perfringens. The physicochemical variables were analyzed according to the protocols established by the Standard Methods for Examination of Water and Wastewater. For microbiological variables, such as Escherichia coli and total coliforms, it was used the “pour plate” technique with Chromocult Coliform Agar (Merk Cat. No.1.10426) serving as the culture medium, while the microorganism Clostridium perfringens was analyzed through the filtering membrane technique, with the Ágar m-CP (Oxoid Ltda, England) serving as the culture medium. Approximately 74% of total COD was removed in the UASB reactor, and the complementary removal done during the flotation process resulted in 88% of COD removal from the raw sewage, thus the initial concentration of COD of 729 mg.L-1 decreased to 87 mg.L-1. Whereas, in terms of particulate COD, the overall removal efficiency for the whole system was about 94%, decreasing from 375 mg.L-1 in raw sewage to 29 mg.L-1 in final effluent. The UASB reactor removed on average 77% of the TSS from raw sewage. While the dissolved air flotation process did not work as expected, removing only 30% of TSS from the anaerobic effluent. The final effluent presented an average concentration of 38 mg.L-1 of TSS. The turbidity was significantly reduced, leading to an overall efficiency removal of 80% and a final turbidity of 28 NTU.The treated effluent still presented a high concentration of fecal pollution indicators (E. coli, total coliforms, and Clostridium perfringens), showing that the system did not present a good performance in removing pathogens. Clostridium perfringens was the organism which suffered the higher removal by the treatment system. The results can be considered satisfactory for the physicochemical variables, taking into account the simplicity of the system, besides that, it is necessary a post-treatment to improve the microbiological quality of the final effluent.

Keywords: dissolved air flotation, municipal sewage, UASB reactor, treatment

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Authors: Marivane Turim Koschevic, Maycon dos Santos, Marcello Lima Bertuci, Farayde Matta Fakhouri, Silvia Maria Martelli

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Natural fibers are rich raw materials in cellulose and abundant in the world, its use for the cellulose nanocrystals extraction is promising as an example cited is the cattail, macrophyte native weed in South America. This study deals with the pre-treatment cattail of crushed fibers, at six different methods of mercerization, followed by the use of bleaching. As a result, have found The positive effects of treating fibers by means of optical microscopy and spectroscopy, Fourier transform (FTIR). The sample selected for future testing of cellulose nanocrystals extraction was treated in 2.5% NaOH for 2 h, 60 °C in the first stage and 30vol H2O2, NaOH 5% in the proportion 30/70% (v/v) for 1 hour 60 °C, followed by treatment at 50/50% (v/v) 15 minutes, 50°C, with the same constituents of the solution.

Keywords: cellulose nanocrystal, chemical treatment, mercerization, natural fibers

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Authors: S. Arabnejad, D. W. C. Cheong, H. Chaobin, V. P. W. Shim

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Debonding is the one of the fundamental damage mechanisms in particle field composites. This phenomenon gains more importance in nano composites because of the extensive interfacial region present in these materials. Understanding the debonding mechanism accurately, can help in understanding and predicting the response of nano composites as the interface deteriorates. The small length scale of the phenomenon makes the experimental characterization complicated and the results of it, far from real physical behavior. In this study the damage process in nylon-6/silica interface is examined through Molecular Dynamics (MD) modeling and simulations. The silica has been modeled with three forms of surfaces – without any surface treatment, with the surface treatment of 3-aminopropyltriethoxysilane (APTES) and with Hexamethyldisilazane (HMDZ) surface treatment. The APTES surface modification used to create functional groups on the silica surface, reacts and form covalent bonds with nylon 6 chains while the HMDZ surface treatment only interacts with both particle and polymer by non-bond interaction. The MD model in this study uses a PCFF force field. The atomic model is generated in a periodic box with a layer of vacuum on top of the polymer layer. This layer of vacuum is large enough that assures us from not having any interaction between particle and substrate after debonding. Results show that each of these three models show a different traction separation behavior. However, all of them show an almost bilinear traction separation behavior. The study also reveals a strong correlation between the length of APTES surface treatment and the cohesive strength of the interface.

Keywords: debonding, surface treatment, cohesive response, separation behaviour

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Authors: Chung-Yu Wu, Chia-Chi Chang, Wei-Ming Chen, Pu-Wei Wu, Shih-Fan Chen, Po-Chun Chen

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Electrostimulation medical devices for neural diseases require electroactive and biocompatible materials to transmit signals from electrodes to targeting tissues. Protection of surrounding tissues has become a great challenge for long-term implants. In this study, we designed back-end processes with compatible, efficient, and reliable advantages over the current state-of-the-art. We explored a hermetic packaging process with high quality of adhesion and uniformity as the biocompatible devices for long-term implantation. This approach is able to provide both excellent biocompatibility and protection to the biomedical electronic devices by performing conformal coating of biocompatible materials. We successfully developed a packaging process that is capable of exposing the stimulating electrode and cover all other faces of chip with high quality of protection to prevent leakage of devices and body fluid.

Keywords: biocompatible package, medical microelectronics, surface coating, long-term implantation

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Authors: Mohammed M. Mahdy Tawfeek

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Objective: The aim of this work is to compare the outcome of photoactivated chromophore for keratitis-cross linking (PACK-CXL) window absorption (WA) alone with combined PACK-CXL WA and standard anti-microbial therapy (SAT) for the treatment of infectious keratitis. Patients and Methods: This is a randomized prospective comparative clinical trial. Thirty eyes with clinically suspected infectious keratitis were randomly assigned into two equal groups of 15 eyes each: Group (A) was treated by PACK-CXL WA alone and group (B) was treated by PACK-CXL WA combined with SAT. Identification of organisms was made by lab study before treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT (AS-OCT). Written informed consent was obtained from all participants and the study was approved by the research ethics committee of the Faculty of Medicine, Zagazig University. The work has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for studies involving humans. Results: Complete healing and resolution (Successful treatment) were observed in 10 eyes (66.7%) of a group (A) and 14 eyes (93.3%) of group (B) and failure was observed in 5 eyes (33.3%) of a group (A) and one eye (6.67%) of group (B). They were statistically significant (P =0.042 and 0.003) in a comparison between both groups regarding success and failure of treatment, respectively. Complete corneal healing was reported in the third month postoperatively in 10 eyes (66.7%) of group (A) and 14 eyes (93.3%) of group (B). Complications were absent in 12 patients (80%) in group (A) and 14 patients (93.3%) of group (B); however, perforation and impending perforation were found in 3 patients of group (A) and only one patient of group (B). Conclusion: PACK-CXL is a promising, non-invasive treatment option for infectious keratitis, especially when performed with the window absorption (WA) technique, either alone or combined with SAT. It has a synergistic effect with a standard antimicrobial treatment that gives good outcome results in the treatment of infectious keratitis. Also, it avoids the antibiotics resistance that has become rapidly spreading worldwide.

Keywords: corneal cross linking, infectious keratitis, PACK-CXL, window absorption

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Authors: Molly Parker

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Unintended pregnancy rates in Australia are amongst the highest in the developed world. Women with Substance Use Disorder often have riskier sexual behavior with nil contraceptive use and face disproportionately higher unintended pregnancies and Sexually Transmitted Infections, alongside Substance Use in Pregnancy (SUP) climbing at an alarming rate. In an inner-city Drug and Alcohol (D&A) service, significant barriers to sexual and reproductive health services have been identified, aligning with research. Rapid pathways were created for women seeking D&A treatment to be referred to Sexual and Reproductive Health services for the administration of Long-acting reversible contraception (LARC) and sexual health screening. For clients attending a D&A service, this is an opportunistic time to offer sexual and reproductive health services. Collaboration and multidisciplinary team input between D&A and sexual health and reproductive services are paramount, with rapid referral pathways being identified as the main strategy to improve access to sexual and reproductive health support for this population. With this evidence, a rapid referral pathway was created for women using the D&A service to access LARC, particularly in view of fertility often returning once stable on D&A treatment. A closed-ended survey was used for D&A staff to identify gaps in reproductive health knowledge and views of referral accessibility. Results demonstrated a lack of knowledge of contraception and appropriate referral processes. A closed-ended survey for clients was created to establish the need and access to services and to quantify data. A follow-up data collection will be reviewed to access uptake and satisfaction of the intervention from clients. Sexual health screening access was also identified as a deficit, particularly concerning due to the higher rates of STIs in this cohort. A rapid referral pathway will be undergoing implementation, reducing risks of untreated STIS both pre and post-conception. Similarly, pre and post-intervention structured surveys will be used to identify client satisfaction from the pathway. Although currently in progress, the research and pathway aim to be completed by December 2023. This research and implementation of sexual and reproductive health pathways from the D&A service have significant health and well-being benefits to clients and the wider community, including possible fetal/infancy outcomes. Women now have rapid access to sexual and reproductive health services, with the aim of reducing unplanned pregnancies, poor outcomes associated with SUP, client/staff trauma from termination of pregnancy, and client/staff trauma following the assumption of care of the child due to substance use, the financial cost for out of home care as required, the poor outcomes of untreated STIs to the fetus in pregnancy and the spread of STIs in the wider community. As evidence suggests, the implementation of a streamlined referral process is required between D&A and sexual and reproductive health services and has positive feedback from both clinicians and clients in improving care.

Keywords: substance use in pregnancy, drug and alcohol, substance use disorder, sexual health, reproductive health, contraception, long-acting reversible contraception, neonatal abstinence syndrome, FASD, sexually transmitted infections, sexually transmitted infections pregnancy

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Authors: Intisar S. A. Elzein

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In Saudi Arabia parts of Nigella sativa, and Calotropis procera are commonly used in folk medicine for the treatment of asthma, bronchitis, cough, eczema and other diseases. The purpose of the study is to identify chemical constituents of Nigella sativa seed and Calotropis procera leave isolated by the bioassay guided fractionation process and find out their relevance to the alleged efficacy of the plant in treating asthma. The medicinal properties of both plants for asthma treatment referred to the rich abundance of thymoquinone and phytol compounds isolated from the essential oil of their seed and leave extracts, which they can form a part of molecules of vitamin K.

Keywords: asthma, Calotropis procera, chemical constituents, Nigella sativa, vitamin K

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Authors: Anna Vildová, H. Hendrychová, J. Kubeš, L. Tůmová

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The abiotic elicitation is one of the methods for increasing the secondary metabolites production in plant tissue cultures and it seems to be more effective than traditional strategies. This study verified the use of silver nitrate as elicitor to enhance flavonolignans and flavonoid taxifolin production in suspension culture of Sylibum marianum (L.) Gaertn. Silver nitrate in various concentrations (5.887.10-3 mol/L, 5.887.10-4 mol/L, 5.887.10-5 mol/L) was used as elicitor. The content of secondary metabolites in cell suspension cultures was determined by high performance liquid chromatography. The samples were taken after 6, 12, 24, 48, 72 and 168 hours of treatment. The highest content of taxifolin production (2.2 mg.g-1) in cell suspension culture of Silybum marianum (L.) Gaertn. was detected after silver nitrate (5.887.10-4 mol/L) treatment and 72 h application. Flavonolignans such as silybinA, silybin B, silydianin, silychristin, isosilybin A, isosilybin B were not produced by cell suspension culture of S. marianum after elicitor treatment. Our results show that the secondarymetabolites could be released from S. marianum cells into the nutrient medium by changed permeability of cell wall.

Keywords: Silybum marianum (L.) Gaertn., elicitation, silver nitrate, taxifolin

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Authors: Magdalena Korytowska, Gunnar Lengstrand, Cecilia Larsson Wexell

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Background: Breast cancer (BC) is the most common cancer among women worldwide, and cases are continuing to increase in Sweden. Bone is the most common metastatic site in breast cancer patients, where > 65-75% of women with advanced breast cancer develop bone metastases during their disease. To prevent the skeletal-related events of metastases (e.g., pathological fractures, bone loss, cancer-induced bone pain, and hypercalcemia bone), two different classes of antiresorptive medications (AR), bisphosphonate and denosumab are typically administered every 3 to 4 weeks. Since 2015, adjuvant bisphosphonate treatment has been used every six months for three to five years in postmenopausal women for the prevention of skeletal metastases and improved survival. Methods: A case-control study was conducted to test the hypotheses that patients treated with high-dose AR are at higher risk of developing MRONJ than breast cancer patients with adjuvant bisphosphonate treatment at a lower dose. Medical and odontological data was collected between 2015-2020. Assessment of oral health and dental care before and during oncological treatment took place at the specialist clinic for Orofacial medicine linked to the specific hospital. Results: In total, 220 patients were included, 101 patients in the high-dose group and 119 patients in the adjuvant BP-treatment group. MRONJ was diagnosed in 13 patients (14%) in the high-dose group. The mandible was affected in most of the cases (84.6%), with a mean duration of high-dose treatment of 19.7 months. In 46.2% of cases, no dental cause of MRONJ could be identified. Overall, estrogen receptor-positive (ER+) BC was the most representative type in 172 patients (78.2%). However, this was 83.9% in the high-dose cases group. The most used drug was denosumab. Twenty-five patients (26.9%) switched their medication from ZOL to denosumab during their oncological treatment. Patients with ER+ breast cancer were reported in 88 patients (87.8%) in the adjuvant group that was treated with ZOL. Conclusions: MRONJ was diagnosed only in the high-dose AR group. Dental assessment and care of patients in the adjuvant group should be considered, with a recommendation to potentially prolong ZOL treatment from 3 to 5 years, with concomitant use of hormonal therapy in patients diagnosed with ER+ breast cancer to prevent bone loss induced by oncological treatment. A new referral for dental assessment is very important in the case of bone metastases when treatment with high dose AR will be required since it is associated with a higher risk of MRONJ.

Keywords: antiresorptive therapy, breast cancer, dental care, MRONJ

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